Malaria in Vietnam, Thailand, Bali

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QUESTION:

I am 5 months pregnant and I was thinking about going on holiday to Vietnam, Thailand, or Bali. What is the risk of malaria in this countries?

 

RESPONSE:

Malaria transmission occurs in all of the nations you mention, though certain areas within these nations are lower risk.

You can find out more about specific regions and local antimalarial resistance patterns at the CDC website.

You should certainly consult your prenatal doctor to discuss the variety of potential risks, in addition to malaria, associated with international travel in the developing world as you enter the third trimester of pregnancy. Malaria infection in pregnant women can be more severe than in nonpregnant women and can increase the risk for adverse pregnancy outcomes. For these reasons, and because no chemoprophylactic regimen is completely effective, women who are pregnant are usually advised to avoid travel to areas with malaria transmission if possible. If travel to a malarious area cannot be deferred, chemoprophylaxis is essential. Chloroquine containing medications are have not been found to have harmful effects on the fetus. For pregnant women travelling to areas where chloroquine resistance is present, mefloquine is usually recommended.

 

 

Malaria from Vietnam War

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QUESTION:

If my husband contracted malaria from serving in the Vietnam War but has never been treated for it, what are the symptoms that he might have experienced in the past that could have been caused by malaria but not diagnosed correctly?

Also is it possible that malaria infection could cause any type of birth defects to his children?

 

ANSWER:

Most people with primary malaria infection experience fevers, chills, sweats, muscle and joint aches, often accompanied by headache, nausea and diarrhea. While these symptoms resemble those of other illnesses that cause fever, these are often more severe in malaria and tend to recur in one, two, or three day cycles.

Certain forms of malaria can relapse  years after infection, and the symptoms of these relapses are similar to the initial (primary) infection.  Anemia, enlarged spleen, and low platelets are also common abnormalities in malaria. If your husband experiences any episodes of these symptoms, blood tests taken during fever might help determine if the malaria parasite is present. Other blood tests can determine if he’s been infected in the past.

While maternal malaria during pregnancy can increase the risk of poor pregnancy outcomes, malaria is not known to increase the risk of birth defects from father to child.

 

Malaria Fever and Recovery

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QUESTION

My 21 year old daughter spent 4 months on a study abroad program in Dakar. A week before returning home she started having night fevers and would complain of retrosternal pain and rib and neck and shoulder pain. The next day she would be fine.

The episodes came every other day and eventually it occurred to her that it might be malaria. It was evening so she went to a pharmacy for a rapid diagnostic test which they didn’t have but they felt she had malaria based on her symptoms and gave her a 3 day course of artesunate-mefloquine.

She returned to the United States and a day after taking her last dose, she was seen by a physician and tests were done which showed that she had contracted Plasmodium falciparum malaria. Other than the smears, all her lab tests and CXR were normal and there were no abnormal findings on physical exam, in fact she was the picture of health.

We were told that she was cured and that no follow up was necessary and that she could continue with her planned trip to Thailand the next day. About 6 hours before boarding the plane to Bangkok she developed fever of 100.9 but had absolutely no other symptoms or pain. About an hour later she had a bout of diarrhea. She had one more low grade fever on the flight (99.8). I spoke to another physician who seems more familiar with malaria and was told that she is not actually cured and may continue to have episodic fevers and symptoms for a while or it’s possible she was just suffering from an ordinary garden variety gastrointestinal bug.

I have many questions. I understand that her malaria is the most virulent type. How is it that all her lab work and physical exam is normal 1 day after completing treatment? Can we expect it to remain normal? What causes the episodic fevers if she is supposedly cured? She is on doxycycline again prophylactically (which she was on in Senegal) while in Thailand. Should she be on something else since she did contract malaria on doxycycline? (She took it religiously). Thanks for any advice. She will be seeing a physician in Bangkok ASAP, but since I won’t be there to ask questions, I am hoping you can give me some answers. Your site is the best information I have found on malaria.

ANSWER

Many thanks for the comprehensive information you have provided regarding your daughter’s condition. Even though your daughter did have the most virulent form of malaria, she was very smart to seek treatment relatively promptly, and lucky to receive appropriate medication (artemisinin-based combination therapies, such as artesunate-mefloquine, are recommended by the World Health Organization as first-line treatment against malaria). It is likely due to this prompt and effective action that her lab tests and blood parameters were all normal so soon after treatment; had she waited longer for treatment, the consequences could have been much more severe. No resistance to this medication has been detected in Africa as of yet, so she should be fully cured and thus her health should remain stable; a blood smear, where her blood is examined under a microscope, can determine this; this is a very standard procedure so could easily be carried out in Thailand if she wants.

Fever is a side effect of the body’s immune system responding to a disease threat, so it is not uncommon for some symptoms to carry on after treatment. In addition, mild side effects of anti-malarial medication can often mimic the symptoms of malaria itself, including fever and nausea.

Given also the (entirely reasonable) possibility of an additional, unrelated stomach bug, I suspect that your daughter has successfully beaten off this malaria attack, and while she should remain vigilant if similar symptoms arise again, her health in the future should not be adversely affected at all by this episode.

Also, as mentioned briefly above, medical professionals in Thailand should be well equipped to diagnose and treat malaria if she suspects she has been reinfected. It is worth noting that malaria in south-east Asia has shown signs of resistance to mefloquine (as well as other drugs, such as chloroquine and sulfadoxine-pyrimethamine), so if she does require treatment while there, she should make sure the medication they provide does not contain any of the afore-mentioned compounds.

Regarding doxycycline, it’s great that your daughter took it religiously—that is certainly the first step towards protection. Randomized placebo controlled trials have shown it is between 92-96% effective in preventing P. falciparum malaria, which is very good, but obviously not 100% perfect – even when taken perfectly, some infections do occur. In addition, there is some data which suggests that dairy products, taken together with doxycycline, may limit  the uptake of the drug. This is rarely communicated to patients, who are instead contrarily told sometimes that taking the pills together with dairy products can reduce side effects! As such, please let your daughter know that she should avoid dairy products for 2-3 hours around the time she takes her doxycycline.

Malaria Statistics 2008-2012

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QUESTION

Where i go if i want statistic of malaria from 2008-2011

ANSWER

Without more information, I am assuming you would like statistics on malaria cases and deaths for 2008-2012. The best data on malaria comes from the World Health Organization, which retrospectively publishes its best estimated for malaria in its annual World Malaria Reports. Each report publishes the figures from the previous year, and the 2012 report has not yet been published, so at this point the WHO can only provide data for 2008-2010. It is also worth mentioning that as more information is collected, past estimates can sometimes be revised, but here I will present the figures from each annual report itself, rather than longer retrospective estimates.

In 2008, the number of cases was estimated at 243 million, with 863,000 deaths. In 2009, the report did not explicitly summarize the number of cases, but reported that deaths were down to approximately 781,000. In 2010, the number of cases and deaths both dropped yet further, to an estimated 216 million cases and 655,000 deaths. Despite these gains, the aim is to work towards a world with no malaria deaths at all by the year 2015, so much control work remains to be done.

Rash and Malaria

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QUESTION

Is random rash-like swelling on parts of your body coupled with back pains and joint aches and cold sweats all malaria symptom? If so, what is the parasite type and the cure?

ANSWER

Rashes are not usually associated with malaria infection; the symptoms you describe are however consistent with several other infections, some of which can be quite serious, such as dengue fever. You should go to your doctor or a hospital to have a blood test which can assist in diagnosing you.

For future reference, if you did have malaria, you would still probably need to have a blood test to determine which species of malaria you had, and therefore what kind of treatment would be appropriate.

Untreated Malaria

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QUESTION

If I am infected with malaria and I get a wrong diagnosis and be treated for flu, can the other symptoms disappear but continue to experience severe headache especially on the right side temple and jawbone area combined with general weakness and numbness in the legs?

ANSWER

Certainly the symptoms of malaria can often be confused with other infections, including flu. Given that treatment for flu will often include anti-fever medications such as aspirin or paracetamol, these drugs may also ameliorate some of the symptoms associated with malaria, without actually curing them.

However, numbness in the legs is not usually characteristic of malaria infection, though headache and weakness could be—again, these are general symptoms of many other infections as well.

If you suspect you have been misdiagnosed and have malaria, you should ask your doctor for a blood test; these can also be carried out at any local hospital or clinic. There, by looking at your blood under a microscope or using it in a rapid diagnostic test, they will be able to determine accurately whether you have malaria.

Diagnostic Blood Test: Malaria in Nepal and India

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QUESTION

My daughter has returned from a 6 week trip to Nepal and then India. About 20 minutes into the flight home she developed pains and aches in her hips and legs, fever, generally feeling dreadful but no nausea or diarrhea. When she arrived after the 10 hour flight her temperature was 100.5. We were concerned about malaria, but when she saw her primary care doctor the next morning she felt much better and her temperature was normal.

Blood taken at that visit showed no sign of malaria, but the doctor said that she could develop a recurrence in 3-4 weeks time when blood test should be repeated to confirm malaria if present.

I don’t doubt her doctor, but do these symptoms suggest malaria? How common is it for an initial episode of malaria to show up as negative on blood tests? She started taking tablets 3 days before entering a high risk area and took them for 3 weeks, but stopped during a brief diarrheal illness and did not restarted her anti malaria tablets.

ANSWER 1 – From Malaria.com Editor:

I think your GP might be mistaken about this – the only way to diagnose malaria is through a blood test which is positive for the disease! I have never heard of any cases where the initial blood test is negative, followed by a positive recurrence several weeks later. There are cases were the initial level of infection is quite low, in which case sometimes the parasites can be missed when looking at the blood film; however, when symptoms are present, this is rare. Moreover, there is no biological reason for a recurrence in several weeks; usually, reoccurrence occurs when treatment is given and for whatever reason is unsuccessful, allowing the malaria parasites to come back (and this assumes they are positively observed in the first place!).

Another diagnostic option, if you want to double check, is to see if you can find a rapid diagnostic test for malaria, which uses a drop of the patient’s blood to look for proteins produced by the malaria parasite. Similarly, there are tests which look for antibodies against malaria; this kind of test, known as serology, is not good for diagnosing active infections since antibodies can persist after the infection has been cleared, but may give you an indication of whether your daughter was exposed to malaria at all during her time in Nepal. Both of these are even more sensitive than blood smears, and although not as common as blood smears, are available in many places, particularly through hospitals which have tropical medicine departments or experts. All in all, if your GP is insisting on a second malaria test in a few weeks, by all means there is no harm in doing that, but in the meantime I would seek a second opinion since I think it is more likely your daughter has another infection (possibly a gastrointestinal bug, or a viral infection) which may risk going undiagnosed if your GP fixates on malaria as the answer.

Regarding the symptoms, unfortunately the symptoms of malaria are very general and it is almost impossible to accurately diagnose the disease on the basis of symptoms alone, hence why a blood test is so important. The blood test, with positive observation of the malaria parasites, is also crucial to determine which species of malaria the patient has, which may have implications for the appropriate treatment.

Answer 2: From Malaria.com Medical Advisor (MD)

The diagnosis of malaria should always be considered for patients with a fever who have traveled to malaria endemic areas. Your concerns that this may be malaria are well founded. Malaria symptoms in the first few days of infection are similar to the early stages of many other febrile illnesses, including viral and bacterial infections. In malaria, the fever also typically waxes and wanes in the manner you described. Confirming the diagnosis requires detecting parasites or their products in a blood sample. The most common test involves inspecting blood under a microscope for the presence of malaria parasites. Sometimes early in the disease there aren’t enough parasites for detection by this method. For this reason, several blood smears taken at 12-24 hour intervals are sometimes required to rule out a diagnosis of malaria in a symptomatic patient.

Additionally, your daughter was vulnerable to infection because she stopped taking antimalaria medicines while traveling in a region of malaria risk. To offer protection, these medicines must be taken for the duration of the stay, and depending on the medicine, up to 4 weeks after the last possible malaria exposure.

Unfortunately most medical doctors in regions where malaria is very rare, like the the United States and Europe, have little experience diagnosing and managing malaria. I would advise you to seek attention at a travel clinic or infectious disease specialist without delay, where it is likely further blood tests will be undertaken immediately to establish laboratory confirmation, and the prompt initiation of treatment for malaria if present.

Malarial Attack Recurring

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QUESTION

My Father aged 65 years was diagnosed with malaria 15 days back and was on medication. Fever was recurring frequently and he had developed a lung infection. Three days back fever stopped and did not occur for 2 days and malarial infection was reducing. Now the Fever has started coming but other parameters are normal. Can you please suggest what needs to be done?

ANSWER

If your father also developed a lung infection, was he treated with antibiotics? If not, his later fever could be caused by that infection, and could be unrelated to the malaria.

He should have another blood test, to look for the malaria parasites; if they are still present, then you should talk to his doctor about trying another type of anti-malarial medication—the World Health Organization recommends artemisinin-based combination therapies (ACTs), such as Coartem, Alu and Duo-Cotecxin, as the first-line treatment against uncomplicated malaria.

However, given that your father appears to have concurrent other medical conditions, it may be that other treatment is more appropriate, and as such it is very important that you check with your doctor before taking additional medication.

Traditional Methods for Malaria Treatment and Prevention

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QUESTION

What are the traditional methods on treating and preventing malaria?

ANSWER

Many different cultures have had their own traditional ways of treating malaria. Perhaps the two best known come from the native tribes in the Western Amazon basin and the ancient Chinese.

Tribes in the Amazon used the bark of a shrub called Cinchona to treat fevers and shivering; Spanish priests in this region observed traditional Quechua healers using this bark and started using it themselves to treat the fevers associated with malaria. Many centuries later, the active ingredient from this bark was isolated and called quinine, which is still used in the treatment of malaria today.

In ancient China, traditional healers would use the plant sweet wormwood (Artemisia annua, to give it its full Latin name), also to treat fevers and the symptoms of malaria. For many hundreds of years, this traditional cure was forgotten about, until the 1970s when a concerted effort led by Mao Tse-Tung began to search for new anti-malarial compounds as part of their Vietnam war effort. Their scientists, led by Dr Youyou, re-discovered sweet wormwood and extracted a potent anti-malarial compound from it, called artemisinin. This compound and and its many derivatives, in the form of artemisinin-based combination therapies (ACTs), are now the mainstay of the World Health Organization’s first-line recommended treatment against uncomplicated malaria.

Malaria Treatment with Fansidar

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QUESTION

My husband has Malaria following a trip to Kenya and has had a fever for three days. We are in Russia and the only drug available at the pharmacy was Fansidar (we also have some Doxcycyclin). He took three Fansidar tablets last night and feels better but the fever has still not completely gone. What should we do? Take more Fansidar? Thanks for your help.

ANSWER

A single dose of three tablets is the correct amount for an adult over 45kg in weight—do not take any more. Unfortunately, Fansidar is not recommended as the first-line drug against malaria any more since many strains of P. falciparum (the most dangerous type of malaria, and the most common type in Kenya) now have resistance to Fansidar. This could be one reason why the treatment is not fully successful, though it could also be that the treatment has worked, but it will take a day or two more before your husband fully recovers.

Make sure your husband takes in plenty of fluids, and anti-inflammatory drugs such as ibuprofen might help with the fever and any aches he could also be suffering from.

If your husband is still feeling sick after a few days, you should try to have another blood test to see if the malaria parasites are still present in his blood. If you, you should try to find an artemisinin-based combination therapy, such as Coartem, Duo-Cotecxin or Alu. These are the most effective medications against malaria that are currently available, and are recommended as first-line treatment by the World Health Organization (for uncomplicated malaria).